Prevention of Future Deaths reports · 2014

Rosemary Simpson

Regulation 28 report to prevent future deaths, reference 2014-0142, written 28 Mar 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report28 Mar 2014
Reference2014-0142
DeceasedRosemary Simpson
CoronerSelena Lynch
Coroner areaInner North London
CategoryRoad (Highways Safety) related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

In the Inner London North Coroners Court  

Inquest touching the death of Dr Rosemary Simpson 

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

 Director of Culture and Environment, London Borough of 

Camden 

1 

CORONER 

I am Selena Lynch assistant coroner, for the coroner area of Inner North London  

2 

CORONER’S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. 

3 

INVESTIGATION and INQUEST 

I concluded an inquest into the death of Dr. Rosemary Anne Simpson on 28th March 
2014. The conclusion of the inquest was “road traffic collision”.   

4 

CIRCUMSTANCES OF THE DEATH 
At about 5.20 pm on 14 January 2014 a double decker bus pulled away from a bus stop 
outside the Grafton Hotel in Tottenham Court Road.  It was necessary for the bus to 
move over to the right, across three lanes, so that it was at an angle when it came to a 
stop between the stop line and the studs of a pedestrian crossing. As the lights changed 
to flashing amber Dr. Simpson crossed the road from west to east, at a running pace.  
The bus driver did not see her and moved off.  Dr Simpson was struck by the front near 
side of the bus and fell to the ground.  She died from her injuries on 28th January 2012. 

5 

CORONER’S CONCERNS 

During the course of the inquest the evidence revealed matters giving rise to concern. In 
my opinion there is a risk that future deaths will occur unless action is taken. In the 
circumstances it is my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.  –  

[BRIEF SUMMARY OF MATTERS OF CONCERN] 
The area is often very busy with pedestrian and vehicular traffic and pedestrians 
frequently cross on the flashing lights, sometimes at speed. Visibility for buses can be 
affected by the siting of the bus stop, so that some routes have to cross three lanes in a 
short distance.  It is not possible to move the bus stop at the present time.   

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you have the 
power to take such action.  It has been suggested by accident investigators that 
countdown markers and pedestrian sensors would improve safety and prevent future 

1

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 collisions.    

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 24th May 2014. I, the coroner, may extend the period. 

Your response must contain details of action taken or proposed to be taken, setting out 
the timetable for action. Otherwise you must explain why no action is proposed. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the family of the deceased 
and to the representative for the driver of the bus.   

I am also under a duty to send the Chief Coroner a copy of your response.  

The Chief Coroner may publish either or both in a complete or redacted or summary 
form. He may send a copy of this report to any person who he believes may find it useful 
or of interest. You may make representations to me, the coroner, at the time of your 
response, about the release or the publication of your response by the Chief Coroner. 

9 

28th March 2014                                                                                   Selena Lynch 

2

Related reports

Other reports by Selena Lynch

See all →

More reports categorised “Road (Highways Safety) related deaths”

See all →

Track Road (Highways Safety) related deaths

See every Prevention of Future Deaths report matching Road (Highways Safety) related deaths, and how often a new one appears.

What would an alert for this have sent me? Search the full text

Free to try — the preview shows the real matches and how many arrived in the last 12 months. Your first email alert is free.

These reports are published by the Chief Coroner's office at judiciary.uk and are © Crown copyright. The text here is reproduced from the published PDF so it can be searched. If something on this page is wrong, or you are a person named in it and want it reviewed, email drcjar@gmail.com and we will act promptly.